TCM Patterns Behind Endometriosis and PCOS

By Makari Wellness, updated September 5, 2026

When the pain keeps coming back: why Chinese herbal medicine looks deeper

You've done everything the right way. You've tracked your cycles, managed your diet, tried the medications, maybe even had a procedure. And yet — every month, the pain returns. The bloating. The fatigue that shows up on a schedule. The sense that something is fundamentally off and your body is trying to tell you something that no one has quite translated yet.

Chinese medicine has been studying this terrain for over two thousand years. Not with MRIs or laparoscopes, but through careful, patient observation of patterns — how pain moves, what time of the month it peaks, what color the blood is, what makes it better or worse, how the pulse changes from week to week. The result is a diagnostic framework that adds another layer to the western picture, and a materia medica with centuries of clinical use.

A large 2026 network meta-analysis published in Frontiers in Medicine (Liu W et al.) reviewed 107 randomized controlled trials on blood-invigorating Chinese herbal formulas for endometriosis. It reported that, combined with conventional therapy, these formulas were associated with improvements in pain, hormonal markers, inflammation markers, cyst size and recurrence, with Guizhi Fuling wan ranking first overall. It is a substantial body of controlled research, and a reason to take the classical formulas seriously alongside medical care.

Here's how TCM understands what those herbs are doing, and how it thinks about the conditions they are used for.

The Western picture (and where it gets complicated)

Endometriosis, PCOS, dysmenorrhea, irregular cycles, fibroids, PMS — western gynecology groups these as distinct diagnoses with distinct treatment protocols. And it is good at what it does: imaging finds lesions, hormones are measured, surgeries remove tissue, medications suppress cycles.

Medical treatment often focuses on the manifestation. Hormonal suppression can help while it's in use, and it isn't designed to change why the body produces this pattern in the first place, so symptoms can return when it stops.

Chinese medicine doesn't replace any of this. It adds a layer: why is this body doing this, and what does it need that it isn't getting? The answer, in TCM, is always a pattern — a specific configuration of imbalance that has a name, a set of symptoms, and a treatment principle. If you want the full background on how Traditional Chinese Medicine works, we have a complete overview on the site.

The six core TCM patterns in OB-GYN

Most gynecological conditions in Chinese medicine reduce to a combination of six patterns. Many people carry more than one — and which pattern is dominant shapes how a practitioner approaches treatment.

1. Blood Stasis (Xuè Yū, 血瘀)

This is the central pattern in endometriosis, and the target of the blood-invigorating herbs the 2026 meta-analysis studied. In Chinese medicine, healthy menstrual blood flows freely and clears completely. When blood stagnates — from cold, from Qi constraint, from emotional holding, from prior trauma — it accumulates in the pelvic region, which TCM relates to the adhesions, cysts and displaced tissue that western medicine finds.

Signature symptoms:

• Fixed, stabbing pelvic pain — often worse before the period begins and relieved when bleeding starts
• Dark, clotted menstrual blood — clots that must pass before pain eases
• Pain that is worse with pressure, better with warmth in cold-type presentations
• Purple or dusky tinge to the tongue, possibly with purple spots on the sides
• Wiry or choppy pulse
• History of: endometriosis, fibroids, ovarian cysts, pelvic inflammatory disease, prior surgery

The herbs: the blood-invigorating materia medica includes some of the most well-studied herbs in the Chinese pharmacopeia. Guizhi Fuling wan (Guì Zhī Fú Líng Wán) — cinnamon twig, poria, peach kernel, moutan bark, and red peony — is a classical example for Blood Stasis with cold in the uterus. Shaofu Zhuyu Tang (Shào Fù Zhú Yū Tāng, Drive Out Blood Stasis in the Lower Abdomen) is traditionally associated with stasis in the lower abdomen with severe pain. Huoxue herbs like Danshen (Dān Shēn, 丹参), Chuanxiong (Chuān Xiōng, 川芎), and Yimucao (Yì Mǔ Cǎo, 益母草, Chinese motherwort) are frequently combined into both classical and modified formulas for this pattern. Herbs that clear heat play a key role when heat has developed alongside the stasis.

2. Liver Qi Stagnation (Gān Qì Yū Jié, 肝气郁结)

The Liver, in Chinese medicine, governs the free flow of Qi throughout the body — and it governs the menstrual cycle. When Liver Qi stagnates (usually from emotional stress, frustration, suppressed feeling, or chronic tension), the cycle loses its rhythm. PMS is often the clearest expression of this pattern, but it also underlies irregular periods, painful ovulation, and the mood component of endometriosis and PCOS.

Signature symptoms:

• Premenstrual irritability, mood swings, anger, anxiety — symptoms that worsen notably before the period and ease once bleeding begins
• Breast tenderness and distension in the week before menstruation
• Bloating, sighing, a sense of pressure in the chest or ribcage
• Irregular cycles — periods that come early when stress peaks, late when depleted, skipping under extreme pressure
• Mild cramping that is crampy-distending rather than stabbing
• Wiry pulse, especially in the Liver position

The herbs: Xiao Yao San (Xiāo Yáo Sǎn, Free and Easy Wanderer) is one formula traditionally associated with this picture in Chinese gynecology. In Chinese medicine terms, Bupleurum (Chai Hu, 柴胡) is traditionally used to dredge the Liver; Peony (Bái Sháo, 白芍) to nourish the blood and soften the Liver; Dong Quai (Dāng Guī, 当归) to move blood and regulate cycles; Poria (Fú Líng, 茯苓) to calm the mind. Together they are classically described as addressing the Liver-Spleen disharmony at the root of hormonal mood cycling. The connection between stress and the Liver system is central in TCM, and it is often addressed with acupuncture alongside herbal medicine. When heat has developed (the tongue turns red, sleep is disturbed), a practitioner might consider a variant instead — a classical example is Jia Wei Xiao Yao San, which adds moutan bark and gardenia to clear it.

3. Blood Deficiency (Xuè Xū, 血虚)

Blood Deficiency is one of the most common underlying patterns in women's health — and one of the most underrecognized. The Liver stores blood; when the body doesn't have enough (from poor diet, overwork, blood loss, or chronic illness), the cycle becomes pale, scanty, and late. This pattern frequently underlies PCOS presentations with thin uterine lining, hypothalamic amenorrhea, and the fatigue-dominated picture of endometriosis.

Signature symptoms:

• Pale, watery, or scanty menstrual blood — the period that "barely shows up"
• Late cycles (more than 30 days), or periods that come infrequently
• Fatigue, especially in the second half of the cycle
• Dizziness or lightheadedness, especially on standing
• Pale complexion, pale lips, pale fingernail beds
• Heart palpitations, difficulty concentrating, poor memory
• Dry skin and hair; brittle nails
• Pale tongue; thin pulse

The herbs: Ba Zhen Tang (Bā Zhēn Tāng, Eight-Treasure Decoction) is a classical example of a Blood and Qi tonic — combining the four-herb Qi formula (Si Junzi Tang) with the four-herb blood tonic (Si Wu Tang: Dong Quai, Rehmannia, Peony, Chuanxiong). Blood Deficiency commonly accompanies disrupted sleep — Chinese herbs for insomnia often address this overlap. Where deficiency has led to cold and the cycle has become very delayed or stopped, the approach differs: a classical example is Wen Jing Tang (Wēn Jīng Tāng, Warm the Menses), which adds warming herbs to move what has become stuck from emptiness rather than excess.

4. Kidney Yang Deficiency (Shèn Yáng Xū, 肾阳虚) — Cold Uterus

In Chinese medicine, the Kidney system governs reproduction. Kidney Yang is the body's warming, activating fire — when it's insufficient, the uterus becomes cold, and the cycle reflects this: late, scanty, pale, with cold cramping that worsens with cold and is relieved by warmth. This pattern is common in infertility, in hypothyroidism-associated menstrual changes, in people who have always "run cold," and in endometriosis presentations dominated by cold rather than heat.

Signature symptoms:

• Cold lower abdomen — often better with a heating pad, worse in winter
• Late or infrequent cycles, pale watery blood
• Persistent lower back ache that is dull and achy, not sharp
• Fatigue that is deep and persistent — not relieved by rest
• Frequent nighttime urination; loose stools; cold hands and feet
• Pallid complexion; low libido
• Pale, swollen tongue; deep, slow pulse

The herbs: You Gui Wan (Yòu Guī Wán, Restore the Right Kidney Pill) is a classical example for Kidney Yang deficiency — in Chinese medicine terms, Aconite root (Fù Zǐ, 附子), Cinnamon bark (Ròu Guì, 肉桂), and Deer antler (Lù Jiǎo Jiāo, 鹿角胶) are traditionally used to restore the Yang fire, while prepared Rehmannia, Dioscorea, and Cornus nourish the Yin that anchors it. Another formula traditionally associated with this picture, Ai Fu Nuan Gong Wan (Ài Fù Nuǎn Gōng Wán, Warm the Uterus Pill), is classically used for cold obstruction in the reproductive system with Mugwort (Ài Yè, 艾叶) as the leading herb.

5. Kidney Yin Deficiency (Shèn Yīn Xū, 肾阴虚)

Where Kidney Yang deficiency produces cold, Kidney Yin deficiency produces heat — specifically a deficiency heat that flares in the afternoon and evening, disturbs sleep, and dries the fluids the body needs to nourish tissue and sustain the cycle. This pattern is classic in perimenopause and menopause, but also appears in younger women with scanty periods, in PCOS presentations with elevated androgens and heat signs, and in endometriosis with prominent heat symptoms.

Signature symptoms:

• Hot flashes and night sweats — the hallmark symptoms
• Scanty, dark menstrual blood, or periods that come early and stop quickly
• Dry throat, mouth, eyes, vagina
• Afternoon fever or flushing; feeling hot in the palms and soles (five-center heat)
• Sleep disturbance: difficulty falling asleep, waking hot at 1–3 AM
• Lower back and knee ache (Kidney domain)
• Red tongue, possibly peeled or cracked; thin rapid pulse

The herbs: Liu Wei Di Huang Wan (Liù Wèi Dì Huáng Wán, Six-Ingredient Rehmannia Pill) is a classical example of a Kidney Yin tonic — in Chinese medicine terms, prepared Rehmannia (Shú Dì Huáng, 熟地黄), Dioscorea (Shān Yào, 山药) and Cornus (Shān Zhū Yú, 山茱萸) are traditionally used to nourish the three yin organs, while Alisma, Poria, and Moutan drain the excess heat and dampness that accumulates from deficiency. When prominent heat signs are present, the classical variant Zhi Bai Di Huang Wan adds Anemarrhena (Zhī Mǔ) and Phellodendron (Huáng Bǎi) to clear the deficiency fire more directly.

6. Damp-Heat in the Lower Jiao (Xià Jiāo Shī Rè, 下焦湿热)

Damp-Heat is the pattern behind many gynecological infections, inflammatory presentations, and the "stuck and hot" quality of certain endometriosis and PCOS cases. This pattern is common in pelvic inflammatory disease, bacterial vaginosis, chronic yeast patterns with heat signs, and endometriosis cases with prominent inflammation and yellow discharge. Chinese herbs for inflammation and herbs that address pain are often central to treatment here.

Signature symptoms:

• Yellow, thick, or foul-smelling vaginal discharge
• Burning or itching sensation in the genital region
• Heavy, dragging sensation in the pelvis
• Painful urination; dark, scanty urine
• Periods that are heavy, prolonged, and bright red to deep red
• Bloating and heaviness that worsens with rich, damp-producing foods (dairy, sugar, alcohol)
• Bitter taste in the mouth; nausea
• Red tongue with yellow, greasy coating; slippery rapid pulse

The herbs: for a strong Damp-Heat picture in the Liver channel — the channel that passes through the genitalia — one formula traditionally associated with it is Long Dan Xie Gan Tang (Lóng Dǎn Xiè Gān Tāng, Gentiana Drain the Liver Decoction), classically described as a strong Damp-Heat-clearing formula. In Chinese medicine terms, Gentiana root (Lóng Dǎn Cǎo, 龙胆草) is traditionally used to drain the heat, and Akebia (Mù Tōng), Alisma (Zé Xiè), and Plantago seed (Chē Qián Zǐ) to drain it through urination. For a milder presentation of the same pattern, a practitioner might consider a gentler approach; classical examples are Er Miao San and San Miao San, which use Phellodendron and Atractylodes. Strong draining formulas are classically used with caution and only under a licensed practitioner's supervision.

How these patterns overlap, and why that matters

In practice, most people present with a combination of patterns rather than a pure single presentation. Someone with endometriosis might have Blood Stasis as the primary driver, Liver Qi Stagnation contributing to the monthly flare, and an underlying Kidney deficiency that explains why she is constitutionally prone to this pattern. Someone with PCOS might show Kidney Yang deficiency alongside Phlegm-Damp obstructing the cycle, with Liver Qi stagnation layered on top.

This is exactly why TCM treatment is individualized. The approach for one person with endometriosis may be entirely different from the approach for another with the same western diagnosis — because the patterns driving it are different. When cold blood stasis predominates, a classical example is Guizhi Fuling wan; when cold and stasis are more severe, a practitioner might consider Shaofu Zhuyu Tang instead; when Liver Qi stagnation is the main driver, a classical example is Xiao Yao San or one of its modified variants.

A note on the research

The 2026 network meta-analysis (Liu W et al., Frontiers in Medicine, PMID 42210952) is a large review of Chinese herbal medicine for endometriosis: 107 randomized controlled trials, five primary outcome measures, a SUCRA ranking system that allowed comparison across 20+ herbal interventions simultaneously. The formulas that rose to the top — Guizhi Fuling wan ranked highest overall, with Danggui Shaoyao San and Shaofu Zhuyu Tang preparations ranking well on inflammatory and cyst outcomes — are classical formulas from texts that are over a thousand years old, now being studied with modern trial methods. As with any meta-analysis, its conclusions depend on the quality of the trials it pools.

Acupuncture and the full picture

Herbal medicine and acupuncture address OB-GYN conditions through complementary mechanisms. Herbs work systemically — supporting constitution, clearing pathogens, nourishing deficiencies over weeks and months. Acupuncture works more immediately and locally: regulating the Liver meridian (LIV-3, LIV-5, LIV-8), activating blood in the lower abdomen (SP-10, SP-6, ST-29, CV-4), warming the uterus with moxa at CV-8 and ST-36, calming the nervous system to reduce the stress component of hormonal dysregulation (PC-6, HT-7).

For dysmenorrhea, acupuncture treatment in the week before menstruation — moving Qi and blood, warming cold, calming stagnation before the cycle peaks — is aimed at easing pain. For conditions like PCOS and endometriosis, TCM practitioners typically think of combined herbal and acupuncture care across several cycles when working on the underlying pattern. The acupuncture and stress relationship is especially relevant here — because Liver Qi stagnation driven by chronic stress is one of the most common pattern-amplifiers in gynecological conditions.

What to expect in a TCM gynecological consultation

If you come to Makari Wellness with a gynecological concern, the initial consultation will look different from what you've experienced at your OB-GYN's office — in a useful way. We'll spend time on your full cycle history: when it started, how it changed over time, what makes it better or worse, what the blood looks like, what accompanies it. We'll look at your tongue. We'll take your pulse in three positions on each wrist, reading the quality and character rather than just the rate.

From this information, we construct a pattern diagnosis — usually a combination of two or three patterns, with one or two primary drivers. The treatment plan follows the patterns: where appropriate, herbal medicine tailored to your specific presentation, acupuncture to address both the acute symptoms and the underlying constitution, and practical guidance on diet and lifestyle factors that support or undermine your pattern. Learn more about how it works at Makari.

The aim is not to manage the condition indefinitely. It is to shift the underlying pattern so the body doesn't need to produce the same symptom every cycle.

Get started

If any of the patterns above sound familiar — if you've been reading this and finding your own symptom picture in one or more of these descriptions — that recognition is where TCM begins. The body is already communicating the pattern. We help translate it.

Schedule a consultation at Makari Wellness. We practice in Oceanside and Rancho Bernardo.

Herbal formulas should only be used under the care of a licensed practitioner; the formulas named here are examples of how patterns differ, not recommendations of what to take. If you are currently under the care of a physician for any of the conditions discussed here, please discuss any integrative treatment with your healthcare team.

References

1. Liu W, Xu L, Jia J, Xu M, Tian Y. Blood-invigorating Chinese herbal medicines plus conventional therapy for endometriosis: a network meta-analysis of 107 randomized controlled trials. Frontiers in Medicine. 2026;13:1776698. DOI: 10.3389/fmed.2026.1776698. PMID: 42210952.
2. Maciocia G. Obstetrics and Gynecology in Chinese Medicine. 2nd ed. Churchill Livingstone; 2011.
3. Lyttleton J. Treatment of Infertility with Chinese Medicine. 2nd ed. Churchill Livingstone; 2013.
4. Chen JK, Chen TT. Chinese Herbal Formulas and Applications. Art of Medicine Press; 2009.

This is general wellness information, not medical advice. Continue care with your gynecologist or physician.

Formulas here illustrate how pattern diagnosis shapes treatment. They are not recommendations; a practitioner selects and adjusts formulas for the individual.

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